Perishock pause

An independent predictor of survival from out-of-hospital shockable cardiac arrest

Sheldon Cheskes, Robert H. Schmicker, Jim Christenson, David D. Salcido, Tom Rea, Judy Powell, Dana P. Edelson, Rebecca Sell, Susanne May, James J. Menegazzi, Lois Van Ottingham, Michele Olsufka, Sarah Pennington, Jacob Simonini, Robert A. Berg, Ian Stiell, Ahamed Idris, Blair Bigham, Laurie Morrison

Research output: Contribution to journalArticle

218 Citations (Scopus)

Abstract

BACKGROUND-: Perishock pauses are pauses in chest compressions before and after defibrillatory shock. We examined the relationship between perishock pauses and survival to hospital discharge. METHODS AND RESULTS-: We included out-of-hospital cardiac arrest patients in the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest who suffered arrest between December 2005 and June 2007, presented with a shockable rhythm (ventricular fibrillation or pulseless ventricular tachycardia), and had cardiopulmonary resuscitation process data for at least 1 shock (n=815). We used multivariable logistic regression to determine the association between survival and perishock pauses. In an analysis adjusted for Utstein predictors of survival, the odds of survival were significantly lower for patients with preshock pause ≥20 seconds (odds ratio, 0.47; 95% confidence interval, 0.27 to 0.82) and perishock pause ≥40 seconds (odds ratio, 0.54; 95% confidence interval, 0.31 to 0.97) compared with patients with preshock pause <10 seconds and perishock pause <20 seconds. Postshock pause was not independently associated with a significant change in the odds of survival. Log-linear modeling depicted a decrease in survival to hospital discharge of 18% and 14% for every 5-second increase in both preshock and perishock pause interval (up to 40 and 50 seconds, respectively), with no significant association noted with changes in the postshock pause interval. CONCLUSIONS-: In patients with cardiac arrest presenting in a shockable rhythm, longer perishock and preshock pauses were independently associated with a decrease in survival to hospital discharge. The impact of preshock pause on survival suggests that refinement of automatic defibrillator software and paramedic education to minimize preshock pause delays may have a significant impact on survival.

Original languageEnglish (US)
Pages (from-to)58-66
Number of pages9
JournalCirculation
Volume124
Issue number1
DOIs
StatePublished - Jul 5 2011

Fingerprint

Out-of-Hospital Cardiac Arrest
Survival
Heart Arrest
Shock
Odds Ratio
Confidence Intervals
Allied Health Personnel
Defibrillators
Cardiopulmonary Resuscitation
Ventricular Fibrillation
Ventricular Tachycardia
Resuscitation
Thorax
Software
Logistic Models
Education

Keywords

  • cardiopulmonary resuscitation
  • heart arrest
  • resuscitation
  • survival

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Cheskes, S., Schmicker, R. H., Christenson, J., Salcido, D. D., Rea, T., Powell, J., ... Morrison, L. (2011). Perishock pause: An independent predictor of survival from out-of-hospital shockable cardiac arrest. Circulation, 124(1), 58-66. https://doi.org/10.1161/CIRCULATIONAHA.110.010736

Perishock pause : An independent predictor of survival from out-of-hospital shockable cardiac arrest. / Cheskes, Sheldon; Schmicker, Robert H.; Christenson, Jim; Salcido, David D.; Rea, Tom; Powell, Judy; Edelson, Dana P.; Sell, Rebecca; May, Susanne; Menegazzi, James J.; Van Ottingham, Lois; Olsufka, Michele; Pennington, Sarah; Simonini, Jacob; Berg, Robert A.; Stiell, Ian; Idris, Ahamed; Bigham, Blair; Morrison, Laurie.

In: Circulation, Vol. 124, No. 1, 05.07.2011, p. 58-66.

Research output: Contribution to journalArticle

Cheskes, S, Schmicker, RH, Christenson, J, Salcido, DD, Rea, T, Powell, J, Edelson, DP, Sell, R, May, S, Menegazzi, JJ, Van Ottingham, L, Olsufka, M, Pennington, S, Simonini, J, Berg, RA, Stiell, I, Idris, A, Bigham, B & Morrison, L 2011, 'Perishock pause: An independent predictor of survival from out-of-hospital shockable cardiac arrest', Circulation, vol. 124, no. 1, pp. 58-66. https://doi.org/10.1161/CIRCULATIONAHA.110.010736
Cheskes, Sheldon ; Schmicker, Robert H. ; Christenson, Jim ; Salcido, David D. ; Rea, Tom ; Powell, Judy ; Edelson, Dana P. ; Sell, Rebecca ; May, Susanne ; Menegazzi, James J. ; Van Ottingham, Lois ; Olsufka, Michele ; Pennington, Sarah ; Simonini, Jacob ; Berg, Robert A. ; Stiell, Ian ; Idris, Ahamed ; Bigham, Blair ; Morrison, Laurie. / Perishock pause : An independent predictor of survival from out-of-hospital shockable cardiac arrest. In: Circulation. 2011 ; Vol. 124, No. 1. pp. 58-66.
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AU - Christenson, Jim

AU - Salcido, David D.

AU - Rea, Tom

AU - Powell, Judy

AU - Edelson, Dana P.

AU - Sell, Rebecca

AU - May, Susanne

AU - Menegazzi, James J.

AU - Van Ottingham, Lois

AU - Olsufka, Michele

AU - Pennington, Sarah

AU - Simonini, Jacob

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N2 - BACKGROUND-: Perishock pauses are pauses in chest compressions before and after defibrillatory shock. We examined the relationship between perishock pauses and survival to hospital discharge. METHODS AND RESULTS-: We included out-of-hospital cardiac arrest patients in the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest who suffered arrest between December 2005 and June 2007, presented with a shockable rhythm (ventricular fibrillation or pulseless ventricular tachycardia), and had cardiopulmonary resuscitation process data for at least 1 shock (n=815). We used multivariable logistic regression to determine the association between survival and perishock pauses. In an analysis adjusted for Utstein predictors of survival, the odds of survival were significantly lower for patients with preshock pause ≥20 seconds (odds ratio, 0.47; 95% confidence interval, 0.27 to 0.82) and perishock pause ≥40 seconds (odds ratio, 0.54; 95% confidence interval, 0.31 to 0.97) compared with patients with preshock pause <10 seconds and perishock pause <20 seconds. Postshock pause was not independently associated with a significant change in the odds of survival. Log-linear modeling depicted a decrease in survival to hospital discharge of 18% and 14% for every 5-second increase in both preshock and perishock pause interval (up to 40 and 50 seconds, respectively), with no significant association noted with changes in the postshock pause interval. CONCLUSIONS-: In patients with cardiac arrest presenting in a shockable rhythm, longer perishock and preshock pauses were independently associated with a decrease in survival to hospital discharge. The impact of preshock pause on survival suggests that refinement of automatic defibrillator software and paramedic education to minimize preshock pause delays may have a significant impact on survival.

AB - BACKGROUND-: Perishock pauses are pauses in chest compressions before and after defibrillatory shock. We examined the relationship between perishock pauses and survival to hospital discharge. METHODS AND RESULTS-: We included out-of-hospital cardiac arrest patients in the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest who suffered arrest between December 2005 and June 2007, presented with a shockable rhythm (ventricular fibrillation or pulseless ventricular tachycardia), and had cardiopulmonary resuscitation process data for at least 1 shock (n=815). We used multivariable logistic regression to determine the association between survival and perishock pauses. In an analysis adjusted for Utstein predictors of survival, the odds of survival were significantly lower for patients with preshock pause ≥20 seconds (odds ratio, 0.47; 95% confidence interval, 0.27 to 0.82) and perishock pause ≥40 seconds (odds ratio, 0.54; 95% confidence interval, 0.31 to 0.97) compared with patients with preshock pause <10 seconds and perishock pause <20 seconds. Postshock pause was not independently associated with a significant change in the odds of survival. Log-linear modeling depicted a decrease in survival to hospital discharge of 18% and 14% for every 5-second increase in both preshock and perishock pause interval (up to 40 and 50 seconds, respectively), with no significant association noted with changes in the postshock pause interval. CONCLUSIONS-: In patients with cardiac arrest presenting in a shockable rhythm, longer perishock and preshock pauses were independently associated with a decrease in survival to hospital discharge. The impact of preshock pause on survival suggests that refinement of automatic defibrillator software and paramedic education to minimize preshock pause delays may have a significant impact on survival.

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